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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Rheumatoid nodules: These are firm, round, non-tender and often multiple cutaneous lesions that are now uncommon. They are found at pressure points in association with friction, particularly extensor surfaces of forearms.
Inflammatory, Hypersensitivity and Immune Lung Diseases, including Parasitic Diseases.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Other patients with rheumatoid arthritis and no industrial exposure may have similar nodules, which appear, cavitate with clefts and disappear, leaving small scars in the lungs, which in turn may calcify. New lesions may appear after others have cleared, and varying stages may be present at the same time, although they often tend to appear in crops, corresponding to generalised clinical exacerbations of the disease, often at the same time as subcutaneous nodules around the elbows or elsewhere. Clearing may be aided by steroids. In a few patients rheumatoid nodules may be found in the lungs, and the patients have a positive rheumatoid factor in the absence of arthritis (Burke et al., 1977). The patient in Illus. RHEUMATOID, Pt. 14a-c showed severe fibrosis before the onset of arthritis, Some nodules appear following other 'insults' e.g. intercurrent disease, local radiotherapy (for breast cancer, etc.).
Rheumatoid arthritis
Published in Gill Wakley, Ruth Chambers, Paul Dieppe, Musculoskeletal Matters in Primary Care, 2018
Gill Wakley, Ruth Chambers, Paul Dieppe
Rheumatoid nodules are commonest at sites of pressure, such as the extensor surface of the forearms. Vasculitis results from the deposition of immune complexes in the vessel wall of small and (occasionally) larger blood vessels. This can cause digital infarction or skin ulcers. Eye conditions that may accompany rheumatoid arthritis include episcleritis or scleritis. Dry eyes as part of Sjögren’s syndrome may present as a late complication. Other neurological complications include peripheral nerves trapped by the swelling of the joints or peripheral neuropathy due to the disease or to medication.
A case of rheumatoid arthritis with multiple lung rheumatoid nodules successfully treated with tofacitinib
Published in Modern Rheumatology Case Reports, 2021
Masahiro Kondo, Yohko Murakawa, Manabu Honda, Takashi Yanagawa, Makoto Nagasaki, Mayuko Moriyama, Yohei Watanabe, Hiroyuki Kakimaru
Rheumatoid nodules (RNs) are found in 25% of patients with rheumatoid arthritis (RA) [1,2]. They often appear in subcutaneous sites subject to pressure, such as over the olecranon and fingers [3,4], but in rare cases (0.4–1% of cases) they are also seen in radiological images of the lungs [5,6]. Most patients with RNs in the lungs are asymptomatic and do not require treatment [7,8]. However, patients with symptoms such as cough, dyspnoea, and haemoptysis should be treated, although a definitive treatment is lacking. The occurrence of lung RNs has been linked to smoking and chronic lung disease, but the precise pathogenesis remains unknown. Recently, cases of lung RNs associated with anti-tumour necrosis factor (TNF) agents have been reported [9–12]. Here, we describe a patient with multiple lung RNs and haemoptysis during treatment with etanercept (ETN) who was then successfully treated with tofacitinib (TOF).
Asymptomatic rheumatoid meningitis revealed by magnetic resonance imaging, followed by systemic rheumatic vasculitis: A case report and a review of the literature
Published in Modern Rheumatology, 2019
Shogo Matsuda, Shuzo Yoshida, Tohru Takeuchi, Yohei Fujiki, Ayaka Yoshikawa, Shigeki Makino
There are more than 20 cases diagnosed with RM by 2016 [29]. RM is difficult to diagnose because there is no specific marker in the blood or CSF. Historically, it has most often been diagnosed on biopsy, but nowadays MRI helps to establish the diagnosis easily without biopsy. Pathological features include chronic inflammation of the meninges, rheumatoid nodules, and vasculitis. Rheumatoid nodules, which are specific for RM, often cannot be detected by biopsy. However, the sensitivity of biopsy for the detection of rheumatoid nodules is low, and Table 3 shows only two cases in which rheumatoid nodules were found on biopsy. Considering this, we think biopsy should be performed only when symptoms are exacerbated and resistance to immunosuppressant therapy develops [35]. In our case, rheumatoid vasculitis (RV) was diagnosed with clinical course, such as increased pericardial effusion, pleural effusion, and bilateral lung consolidation. The vasculitis in RM predominantly affects the smaller parenchymal and meningeal arteries and rheumatic meningitis may be part of central nervous system vasculitis [8]. Our patient’s systemic vasculitis worsened over the course of his hospitalization, and his good response to prednisolone precluded us from performing a biopsy.
Multiple subcutaneous xanthogranuloma at juxta-articular sites with bone cystic changes resembling rheumatoid arthritis: A case report
Published in Modern Rheumatology, 2018
Shoichi Kaneshiro, Kenrin Shi, Kosuke Ebina, Masao Yukioka, Hideki Yoshikawa, Norikazu Murata
From the appearance of multiple subcutaneous nodules at juxta-articular sites, the differential diagnoses should include rheumatoid nodules, multicentric reticulohistiocytosis and pigmented villonodular synovitis. Rheumatoid nodules are often bony hard [7], but the nodules in our case were all soft to elastic soft. Multicentric reticulohistiocytosis, often resembling and misdiagnosed as RA, manifests multiple joint destruction including distal interphalangeal joints [8]. Although the nodules mostly occurred near the joints in our case, joint destruction was not recognized either radiographically or intra-operatively. The lesions of this case had some similarities to pigmented villonodular synovitis, but neither did they locate in synovial-lined tissues, nor have hemosiderin deposition [9]. Finally, these differential diagnoses were all denied by histopathological findings.